Ultrabrief Pulsewidth Electroconvulsive Therapy (ECT) (UB ECT)

Northside Clinic, Australia, The Melbourne Clinic, Australia, St George Hospital, Australia, Wandene Private Hospital, Australia

Electroconvulsive Therapy (ECT) remains essential to contemporary psychiatric practice and is one of the safest and most effective treatments available for depression. Despite modern advances in pharmacotherapy, about 15-20 per cent of all hospitalised patients receive treatment with ECT. Its use, however, is limited by concerns over associated cognitive side effects. Recent research has suggested that using an ultrabrief pulsewidth with ECT may greatly reduce cognitive side effects, while maintaining efficacy (Sackeim et al 2008). Preliminary results were positive for unilateral ECT, however, suggest that for bilateral ECT, dosing may need to be adjusted to preserve efficacy while reducing side effects. This study will examine the relative cognitive side effects and efficacy of right unilateral and bilateral ECT given with a standard pulsewidth or an ultrabrief pulsewidth. Some participants will also receive an MRI scan before and after ECT.

Patients will be treated with an ultrabrief (0.3ms) pulse with a bilateral placement at 3-4 times seizure threshold.

Patients will be treated with a standard (1.0ms) pulse with a bilateral placement at 1.5 times seizure threshold.

Patients will be treated with an ultrabrief (0.3ms) pulse with a right unilateral placement at 8 times seizure threshold.

Patients will be treated with a standard (1.0ms) pulse with a right unilateral placement at 5 times seizure threshold.

Inclusion Criteria: Subjects meet criteria for a DSM-IV-TR Major Depressive Episode Total MADRS score >/= 25 Age >/= 18 years Educated or working in an English medium setting Exclusion Criteria: Diagnosis (as defined by DSM-IV-TR) of any psychotic disorder (lifetime with exception of Major Depressive Episode with psychotic features); rapid cycling bipolar disorder, eating disorder (current or within the past year); obsessive compulsive disorder (lifetime); post-traumatic stress disorder (current or within the past year). history of drug or alcohol abuse or dependence (as per DSM-IV-TR) in the last 6 months (except nicotine and caffeine). ECT in last 3 months Subject requires an urgent clinical response due to inanition, psychosis or high suicide risk unable to give informed consent score < 24 on Mini Mental State Examination

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Loo C, Sheehan P, Pigot M, Lyndon W. A report on mood and cognitive outcomes with right unilateral ultrabrief pulsewidth (0.3 ms) ECT and retrospective comparison with standard pulsewidth right unilateral ECT. J Affect Disord. 2007 Nov;103(1-3):277-81. doi: 10.1016/j.jad.2007.06.012. Epub 2007 Aug 16.

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